59 - Abdominal distention, 60 abdo mass Flashcards
Causes of abdo distention
Fs
Fat Flatus Foetus Faeces Fluid Fibroids Fatal (tumours)
What are ascites? Cause?
Fluid accumulation in peritoneal cavity.
liver cirrhosis, metastates, heart failure, TB, Meig’s,
Ix of ascities?
USS
FBC
LFTs
ascitic tap
Mx of ascites?
manage cause
diuretics
paracentesis - but risk of infection
What is meigs ?
Triad
benign ovarian tumor ascites
pleural effusion that resolves after resection of the tumor.
Usually Ovarian fibromas
Sx / signs of hepatomegaly
Can feel it
May also cause jaundice, bruising, lethargy, weight loss, poor appetite
Causes of hepatomegaly
Infection: mono, hepatitis, abscess, malaria, amoboeasis,
Biliary: PBC, PSC
(Primary sclerosing cholangitis
Primary biliary cholangitis)
Metabolic: haemochromatosis, Wilson’s, glycogen storage diseases
Congenital: haemolytic anemia, sick cell
Neoplastic
Other: alcoholism, sarcoid, drugs,
Causes of splenomegaly
haemolytic anaemia, leukemia, lymphomas, portal hypertension, haemoglobinopathies, AIDS, infections,.
Mx if hyperspenic
splenectomy
Causes of bowel obstruction
mechanical obstruction, adhesions (from previous surgery), hernias, volvulus, tumours, endometriosis, IBD, ischaemic bowel
Sx / signs of bowel obsturction
Abdominal pain, vomiting, bloating, tinkly bowel sounds.
First sign is lack of flatus, then lack of stool.
How does bowel obstruction progress
toxic megacolon or faecal vomiting.
Ix / Mx of obstruction
Give iv fluids and pain medication.
USS, CXR and CT.
Needs urgent surgery.
DO NOT give laxatives.
Causes of volvulus
Malrotattion, Hirschsprung, pregnancy, adhesions,
Obvs needs urgent surgery
PKD can be AD / AR. Signs?
Mass
hypertension, headaches, abdominal pain, haematuria, polyuria leading to renal failure.
Gene in PKD
PKD1-3 leads to faulty polycystin-1 and 2 which leads to cillial defects.
Severe PKD mx
dialysis / transplant
Bowel mass DDx …name 4
obstruction, intussusception, volvulus, pyloric stensosis, cholecystitis, hernias, hepatomegaly, tumour, aneurysm, abcesses, diverticulitis, IBD,
What is pyloric stenosis? usual age?
Narrowing of the connection between the stomach and the duodenum (pylorus)
Usually occurs in the first few months of life. Occurs more in boys.
Signs of pyloric stenosis
Projectile non-bilious vomiting.
olive shaped mass in epigastrium.
Seen on Ix of pyloric stenosis
Capillary blood gas shows a metabolic (hypochloraemic, hypokalaemic) alkalosis due to repeated vomiting. This is diagnostic.
Surgeons usually want an ultrasound.
Mx pyloric stenosis
pyloromyotomy
What is cholecystitis ?
Sx ?
Gallbladder inflammation.
Right upper abdominal pain, nausea, vomiting, fever,
Usual cause of cholecystitis
bile duct blockage
can be vasculitic
Complication of cholecytitis
gallbladder rupture -> empyema
Mx of cholecystitis
cholecytectomy
pain control
Stones can be removed by ERCP
what is ERCP
Endoscopic retrograde cholangiopancreatography
endoscope into bile duct
Gallstones called? Usual Mx
Cholelithiasis.
Most are silent and do not require treatment.
Sx of symptomatic gallstones
Cramping colicky pain in the upper right abdomen. Hepatomegaly, fever, jaundice, dark urine and vomiting
Rfs for gallstones
fat, fair, forty, pregnant, family history, diabetes, liver disease
What are gallstones made from ?
cholesterol / bilirubin
What is the stupid law of courvoisier?
painless jaundice and enlarged gallbladder, the cause is unlikely to be gallstones.
Mx of gallstones
Shock wave lithotripsy
Usual Ca in pancreas ?
Sx? prognosis?
Usually adenocarcinoma.
Disease usually silent. Jaundice, weight loss, back pain, loss of appetite. May secrete
Poor prognosis due to the fact that even non-specific signs indicate advanced disease.
What do people with pancreatic cancer tend to get? mets go where?
DVTs
liver
What is urinary retention
Inability to completely empty the bladder. Can become incredibly painful.
Causes of urinary retention
BPH, neuropathy, constipation, infection, drugs, tumour, iatrogenic, prostatitis, phimosis
Complications of urinary retention?
Stones, infection, rupture
Dx of urinary retention
bladder US
Mx if prostatic cause of urinary retention
foley catheter / prostatic stent
Bladder ca which cells?
urothelium (transitional cell)
Rfs of bladder ca
rubber and polycyclic aromatic hydrocarbons, smoking, genetics, schistosomiasis,
Signs of bladder ca
Haematuria (may be microscopic), dysuria, polyuria, urge,
When does bladder ca have a poor prognosis
when muscle wall is invaded
Ix / Mx bladder ca
Cystoscopy and biopsy
US / CT / MRI
Treat with resection surgery, BCG immunotherapy, chemotherapy
What is diverticulitis?
Arising from diverticulosis: outpouching of large bowel wall
->infection
Sx diverticulitis
Sudden onset lower abdominal pain, fever, nausea, vomiting, constipation, blood in the stool.
rfs diverticulitis
smoking, diabetes, NSAIDs, low dietary fibre
DDx diverticulitis
IBS, IBD, malignancy,
Complications of diverticulitis
Sepsis
bleeds, abscess, perforation, adhesions, fistulas and faecal impaction.
2 key Ix in diverticulitis
CT and colonscopy.
Mx of most diverticulitis
conservative
Skip leisions found in which IBD
crohns
sx of crohns
Abdo pain, loose bloody stools (nature of which decided by section of bowel involved), fever, weight loss.
Anaemia, rash, fatigue, aphthous ulcers, sausage like abdominal mass.
Associations with crohns
primary sclerosing choelycistitis
enteropathic arthiritis
Mx of crohns
Oral pred + methotrexate to maintain remission.
Good evidence for Abx.
Surgical resection rarely works.
2 main complications of crohns
bowel ca
abscesses
Sx of UC
Abdo pain, loose bloody stools, weight loss, anaemia,
Major complications of UC
High risk
bowel ca
megacolon
enteopathic arthritis
Key Ix in IBD
Colonoscopy and biopsy
Mx of UC
Mesalazine. Prednisolone.
Resection may be necessary.
Crohns vs UC
Crohn’s disease Porridge steatorrhea Weight loss, fistulae, fever Skip lesions (‘cobblestone’) Worsened by smoking Full thickness inflammation Granulomas Crypt lesions
UC Mucus-like with blood Tenesmus Continuous inflammation Improved by smoking Peripheral layer involvement No granulomas on histology No crypt lesions
Complications of ovarian cysts
May produce torsion if they twist. Bloating, lower abdo pain.
Can rupture also: vomiting and pain.
Sx of PCOS
Ammenorrhea, heavy periods, obesity, hirsuitism, acne, pain, infertility.
Dx of PCOS
Must have two out of 3: high androgens, anovulation, cysts on ultrasound.
Rfs of PCOS
obesity, lack of exercise, family history,
PCOS associations
T2DM, obesity, OSA, heart disease, endometrial cancer.
How to help fertility issues in PCOS
lose weight
metformin and clomifene
When does ovarian Ca usually happen? Sx?
post-menopause.
Symptoms are non-specific: bloating, pelvic pain.
2 key Ix for ovarian Ca
CA-125
US
What are fibroids? Sx?
Leiomyoma: benign smooth muscle tumours. Rarely malignant.
Painful heavy periods, but can be silent.
Dyspareunia.
Can push on bladder: urinary frequency and pain.
Bloating and discomfort.
Rfs for fibroids
obesity FHx PCOS HTN nulliparity
Mx fibroids
Mild pain relief in mild disease.
Iron supplements may be needed.
Intrauterine system shrinks and manages small disease.
Hysterectomy in severe disease.
When do fibroids often naturally regress
menopause
Complications of fibroids
torsion
compress other things
miscarriage
What is endometriosis? key sx ?
Endometrial tissue present outside of the uterus (ovaries, tubes, bladder, peritoneum, lung).
Dyspareunia, infertility, cyclical pain
Complications of endometriosis
lowered fertility
adhesions
ca
What must you consider in any woman of reproductive age with abdo pain ?
ectopic
Rfs for ectopic
IUD and coil increase incidence. PID, chlamydia, smoking, infertility treatment, previous ectopic,
Major complication of ectopic
rupture
Dx of ectopic
HCG urine dip and ultrasound.
Mx ectopic
methotrexate
surgery
Rfs for hernias
Post-op, congenital, coughing, straining, weight lifting, pregnancy, connective tissue disease are all risks.
